Medicare in Texas
Resources for Texas Medicare Beneficiaries
Want to know about the many parts of Medicare, enrollment periods, and applications, or comparing and choosing a Medicare plan? Dig into our resources on the different parts of Medicare, enrollment, or tips on choosing a Medicare plan.
Getting advice can be helpful while choosing Medicare options. The State Health Insurance Program (SHIP), known as the Texas Health Insurance, Counseling, and Advocacy Program (HICAP), is one of the numerous resources available to Texans for assistance. Texas individuals can get information on Medicare through HICAP counselors who work with neighborhood nonprofits, public health organizations, and Area Agencies on Aging (AAAs) specific to your county.
Medicare Plan Options in Texas
You can choose from a number of Medicare alternatives if you live in Texas. Individuals that are 65+ and those with disabilities that qualify for Medicare can apply for Original Medicare. A Medicare Advantage plan in Texas may be a better choice if you want a more comprehensive coverage. Some Medicare plans options include prescription drug plans or Medicare supplemental insurance.
Original Medicare (Parts A & B)
Your foundational Medicare program is Original Medicare. It is split into Medicare Part A, which covers hospital insurance, and Medicare Part B, which covers medical insurance. Hospital stays, skilled nursing facility stays, home health care, and hospice care are covered in Medicare Part A. Medicare Part B includes coverage for doctor’s visits, outpatient care, lab testing, and preventative services, such as cancer screenings, flu shots, and yearly wellness visits. Medicare Part A and Part B have different deductibles that apply for different services. For example, Part A has an inpatient hospital deductible per benefit period (each time you are admitted), and Part B has an annual deductible before Original Medicare starts to pay. Things to consider if keeping Original Medicare:
- If you want the flexibility to choose and access healthcare providers who accept Medicare anywhere in the United States, Original Medicare in Texas is a fantastic option.
- If you don’t require a lot of health care or prescription drugs, know that there is no cap on what you may pay out of pocket. Stand-alone prescription drug plans are available for these scenarios.
Medicare Advantage (Part C)
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare coverage, which is offered by private insurance companies. These plans cover, at minimum, what Medicare Part A and Medicare Part B would. Most services are administered by a network of providers, who might need you to have a primary care physician, a referral to see a specialist, and prior approval for certain services, treatments, and prescriptions for you to receive them. In Texas, Medicare Advantage means additional coverage for essential services. Medicare Advantage is a good choice if:
- You prefer your health care and drug benefits in one plan and don’t mind being limited to a network of providers you can choose from.
- You only want to carry one ID Card. Present your chosen Medicare Advantage plan’s ID card to your doctor and pharmacy at the time of service.
You want the financial protection of an annual cap on how much you can spend out-of-pocket Medicare-covered costs.
To learn more about Medicare Advantage, explore our Medicare Part C Resource Page.
Medicare Prescription Drug Plan (Part D)
A Part D Prescription Drug Plan (PDP) coverage can be added to Original Medicare or to a Medicare Supplement Insurance policy, but many Medicare Advantage plans already include it by default. Stand-alone Part D plans are provided by private insurers that have been given Medicare approval. Depending on the plan chosen, there may be a deductible, copay, or coinsurance associated with covered medications.
- Part D is a great pick if you have Original Medicare, Medicare Savings Account (MSA), or a Private Fee for Services (PFFS) plan that doesn’t include prescription drugs.
- If you wait to sign up for a Part D plan, you may be assessed a late enrollment penalty unless you already have other creditable coverage, such as an employer-sponsored group plan, retiree plan, or military coverage, to name a few.
- If you don’t need any medications right now, it is recommended to still sign up for a low premium cost Part D plan to avoid late enrollment penalties.
Medicare Supplement Insurance (Medigap)
Some Medicare beneficiaries in Texas buy Medigap, aka Medicare Supplement Insurance. These plans aim to help provide coverage for any gaps left by Original Medicare. For example, a few of these gaps include Part A and Part B deductibles, coinsurance, and coverage for medical care outside of the United States.
You should know that a Medigap plan doesn’t pay for anything related to a Medicare Advantage plan; you cannot have both a Medigap policy and a Medicare Advantage plan simultaneously. Don’t stress:
- Medigap is an excellent choice if you have Original Medicare and want help paying for out-of-pocket costs when you use your Medicare Part A and Medicare Part B benefits.
- You pay a set monthly premium for a policy that will cover most of your out-of-pocket costs associated with Medicare-covered services. So you have peace of mind and no unexpected medical expenses.
- Let’s say you need a lot of healthcare services and want to be able to see any Medicare provider you want; as long as they accept Medicare, your Medigap plan gives you coverage for Medicare-approved care that you can count on.
Medicaid is a state agency that offers coverage and coordinates care with the federal government to offer medical insurance to eligible, low-income individuals that qualify. Medicaid in Texas was created to help those who might not otherwise have access to affordable health care.
How and when to sign up for Medicare in Texas
Medicare is a government-run insurance program supported by the federal government for people who qualify. Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are frequently referred to as Original Medicare. Additionally, since Original Medicare does not cover all of your medical expenses, the Texas Department of Insurance (TDI) suggests obtaining Medicare Supplement Insurance coverage to reduce out-of-pocket costs. The majority of Americans are eligible to enroll in Medicare when they turn 65. The following also triggers Medicare eligibility:
- You qualify for disability benefits from the Railroad Retirement Board or Social Security and are under 65 and permanently disabled and have received disability benefits for at least 24 months from Social Security.
- You are diagnosed with End Stage Renal Disease (ESRD).
- You are diagnosed with Lou Gehrig’s disease, often known as Amyotrophic Lateral Sclerosis (ALS).
Medicare Enrollment Periods in Texas and nationwide
Here is a quick overview of the Medicare enrollment windows and enrollment dates in Texas.
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Want a few fun facts about Medicare coverage in Texas?
- More than 4.4 million people in Texas are enrolled in some type of Medicare plan, which sounds like a lot (and it is, because don’t mess with Texas). Still, that number is technically a bit low because less than 14% of the state’s population has Medicare, compared to 19% nationally.
- As of 2022, 49% of Medicare enrollees in Texas were enrolled in Medicare Advantage plans or other private Medicare programs.
- 930,000 or more Texans are covered by Medigap policies. In Texas, Medigap insurers are required to make at least one plan available to individuals under 65 years of age and Medicare eligible because of a disability.
- In Texas, around 71 different insurance providers offer Medicare Supplement (Medigap) plans.
- And because we promised you a fun fact: Texas is the only state where six different countries’ flags have flown over it. Spain, France, Mexico, the Republic of Texas, the Confederate States, and the United States.
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